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South Dakota rates for HCPCS 69603

Revision mastoidectomy; resulting in radical mastoidectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,284.95 / $1,284.95 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,070.10 / $1,284.95 / $3,518.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,799.77 / $2,936.43 / $3,670.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,296.53 / $2,171.57 / $3,555.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,504.88 / $2,508.14 / $9,546.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,143.00 / $3,359.42 / $5,269.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.00 / $2,807.10 / $3,488.88
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,553.86 / $2,120.96 / $2,495.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,672.96 / $2,633.55 / $3,496.75
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,431.60 / $2,860.70 / $2,975.20